Archive for August, 2010

Bipolar disorder and borderline personality disorder often share many of the same symptoms – mood shifts, emotion dysregulation, impulsivity. In “Is Bipolar Disorder Overdiagnosed in Adults?” I cited a study suggesting that a number of people diagnosed with bipolar disorder actually meet criteria for borderline personality disorder, instead.

So what’s the difference? It’s a complicated discussion. Although some overlap may exist, important distinctions separate the two conditions, yet some researchers believe both conditions are likely a part of a continuum and are, in fact, related to one another.

In this part of a two-part series, I highlight the diagnostic differences between bipolar disorder and borderline personality disorder. In Part II, I focus on differences in treatment for the two conditions.

Development/Nature of the Illness

Borderline personality disorder is a type of “personality disorder” which essentially means that it is a developmental condition – something that has evolved through the entire development of a person’s emotional/behavioral infrastructure.

I often write about the challenges of maintaining a relationship when bipolar disorder seems intent on destroying it, but bipolar disorder can also strengthen relationships. It strips away the facade, exposing vulnerabilities we work so hard to keep hidden. Ultimately, this can lead to a deeper intimacy in the relationship.

Bipolar disorder also tests your mettle, your ability to endure in the midst of adversity, your character. It challenges your commitment and can expose old wounds, so they can be properly attended to. It forces you and your loved one to make potentially life changing choices you should have made but probably never would have considered otherwise.

Many people wonder whether brand name medications are any better or even any different than their generic equivalents. After all, if two medications contain the same amount of the same active ingredient, theoretically, they should be equally effective.

Short Answer

The answer to this question is most often yes. The vast majority of generic medications contain the same active chemical found in the name brand product. When you buy generic acetaminophen instead of Tylenol, you’re getting the same active chemical and typically the same effect. Similarly with generic Prozac (fluoxetine), for example, the products are almost identical, and the effects are almost always very similar.

A recent study published in the Archives of General Psychiatry by researchers at National Institute of Mental Health showed that the medication Ketamine, given intravenously to a small group of people with bipolar depression, caused a rapid antidepressant response in a high percentage of those patients. Their responses were much better than patients given a placebo IV solution.

It may often seem that doctors don’t trust their patients regarding management of their medications, particularly controlled substances, including tranquilizers and stimulants. This is a dilemma that I face all the time in my practice. Some medications are powerful and excellent at treating specific symptoms, such as Xanax for anxiety, but they carry significant risk of dependency and misuse as recreational drugs.

I am a strong believer in using the right medication and not being fearful of using these medications when they are indicated, as long my patient and I engage in ongoing conversations about the risks and that we both carefully monitor their usage.

We often discuss the potential risks to a fetus when the mother is taking psychiatric medications, but we rarely if ever consider the potential risks of a prospective father taking psychiatric medications. One of our readers posted a question addressing this issue.

Heidi asks…

Hi there, my husband started taking Depakote for bipolar disorder several months ago. We are talking about having another baby and are wondering whether it’s safe for us to conceive while he is on Depakote? Any advice is helpful, thanks.

May asks…

I’m wondering if any research has established a link between patients with Bipolar Disorder I or II and nervous system disorders? I’ve suffered from different types of neuralgias for years, as well as IBS and migraines. One of my doctors said she often sees these or similar co-morbidities, but she’s not sure why.

Chronic pain combined with a mood disorder does not make for a very pleasant life. I recently read somewhere that people with chronic pain tend to carry a lot of stress and tension, both physically and psychologically, much like BP sufferers do.